A frequently asked question is what happens when someone does not have all the required vaccines for immigration. This article will discuss the legal options to apply for a vaccination waiver/ exemption, and answer frequently asked questions.
Green card, permanent resident applicants, must undergo a medical examination by a “civil surgeon” (if in the US) or a “panel physician” (if applying from abroad), as part of the process. This doctor will determine whether the applicant meets the vaccination requirements.
What vaccines are required for US immigration?
- Haemophilus influenzae type B (HiB)
- Hepatitis B
- Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices (ACIP):
- An example of this is the flu vaccine during flu season (generally October to March).
- Hepatitis A
- Meningococcal disease
- Pneumococcal disease
Who is Advisory Committee for Immunization Practices (ACIP)?
The ACIP is an advisory committee to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) that recommends immunizations for the general U.S. population. Since Dec.14, 2009, when the ACIP recommends new vaccines for the general U.S. population, CDC assesses whether these vaccines should be required for immigration purposes on a regular and on an as-needed basis
How does the immigration doctor know which vaccines I have had in the past?
You must bring all your vaccination records to the immigration medical exam and the physician will follow those records if the documentation appears valid.
To be acceptable to USCIS, any vaccine dosage record must include the date it was given, including, day, month, and year. The document must not appear to be altered and the dates must seem reasonable. Vaccines used worldwide are acceptable.
Self reported vaccine doses without written authorization are not acceptable.
Vaccination at an immigration medical exam - what does it entail?
The civil surgeon or panel physician will compare your vaccination records and will complete the “vaccination record” section in form I-693 or DS-3025.
Based on the form, as well as your age and documented immunity, he or she will determine what vaccinations are required.
If indicated, you may be offered the vaccines at the appointment.
The doctor will also discuss medical contractions or moral contradiction and may tell the applicant that they may need to apply for a separate vaccine waiver.
Once the doctor completes Form-693 or DS-3025, it will be given to the applicant in a sealed envelope for USCIS. The applicant will also be provided with a copy for their records.
If I do not have a vaccine but have proof of immunity, is this acceptable as an alternative to a vaccine?
Yes, some individuals are immune to vaccine-preventable diseases, and they know of the immunity because their private healthcare provider has tested them. If you have any written evidence of immunity, you should take this documentation to your civil surgeon.
However, this is only acceptable for the following diseases:
- Hepatitis A
- Hepatitis B
How does the CDC determine if I have a medical contradiction for a vaccine?
The doctor that conducts your medical exam will check with the CDC technical instructions as well as any evidence you provide of the medical condition that prevents you from receiving a particular vaccine.
What is a medical contraindication to vaccination for immigration purposes?
A contraindication is a condition that is likely to result in a life-threatening problem if the vaccine is given. A precaution is a condition that might increase the chance of a serious adverse reaction if the vaccine is administered or a condition that might compromise the immune response to the vaccine.
Civil surgeons/ panel physicians are instructed to follow ACIP/ CDC guidance when it comes to contractions.
What happens if I have a medical contraindication to a mandatory vaccine?
The civil surgeon/ panel physician can make a note regarding a “blanket waiver” and will document the vaccine not given as well as the contraindication on form I-693.
What is a “blanket waiver” for immigration purposes?
It is given when it is not appropriate to administer a dose or more of a vaccine, for example, due to age or medical contraindication.
If a blanket waiver is given, the individual is still considered to have completed the vaccination requirements for immigration purposes.
A separate application is not needed for blanket waivers.
In what circumstances is a vaccine considered “not medically appropriate” for immigration purposes?
One of the reasons a blanket waiver may be issued is when a vaccine is “not medically appropriate”. 6 reasons qualify:
- Not age-appropriate - For example, if adults did not receive Hib or rotavirus vaccine as a child, they are not required to receive these vaccines as adults and these vaccines should be documented as “Not age appropriate.”
- Contraindication - If an applicant has contraindications or precautions to specific vaccines. The applicant should bring supporting documentation to their immigration medical. An attorney may be a helpful advocate.
- Insufficient time interval between doses - If the minimum time interval between the last documented dose and the next required dose has not passed. If administration of a single dose of vaccine at the time of the medical examination does not complete the series for that vaccine, the “Insufficient time interval to complete series” reason should be documented to indicate that additional doses will be needed to complete the series for that vaccine. This reason can also be used if a live vaccine has recently been administered and another live vaccine is needed, but sufficient time has not passed.
- Not routinely available- When the required vaccine is not licensed or not routinely available in the country where the panel physician practices.
- Influenza vaccine not available - Influenza vaccine is required when available in the United States. The influenza vaccine is usually given from fall through early spring in temperate areas and is often not available in the summer months in these regions. If influenza vaccine is not available because it is not vaccination season in the United States, document the “Not flu season” reason.
- Known chronic hepatitis B virus infection- If the applicant has a documented history of chronic hepatitis B virus infection, this reason for a Blanket Waiver for hepatitis B vaccine can be given, and the applicant does not need to receive the hepatitis B vaccine. However, testing for hepatitis B virus infection should not be performed as part of the applicant exam.
Does pregnancy or breastfeeding count as a medical contradiction during an immigration medical examination?
The physician that conducts the immigration medical will use the CDCs technical instruction as a guide. If the technical instructions mandate that a specific vaccine is not contraindicated, you may choose to delay the completion of your immigration medical until after birth or breastfeeding, but this will also mean a delay to the completion of your immigration process, unless you apply for a waiver or exemption.
For information about the guidance that will be used by the civil surgeon/ panel physician, see here: https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html
What happens if I do not have a medical contraindication to vaccines but still do not wish to get vaccinated?
You may request a waiver based on religious or moral convictions.
If you object to vaccination based on religious or moral convictions, it must be documented at the immigration medical exam that you are requesting an individual waiver based on religious or moral convictions.
This is not a Blanket Waiver, and you will have to submit a separate waiver request to USCIS, usually in the form of Form I-601.
USCIS will determine whether this waiver is granted, not the panel physician or civil surgeon. CDC does not review this waiver.
If you foresee this being necessary, it will save you time to apply for this waiver at the same time or shortly after you make your immigration application. Waiting until your medical appointment may cause you to experience delays.
If you did not apply for a waiver prior to your immigration interview, the office will likely issue a Request for Evidence for the waiver application. Upon receipt of the waiver documentation, the officer should proceed with the adjudication of the waiver.
What are the main requirements for an immigration vaccination waiver?
You are opposed to all vaccinations in any form– a waiver may not be granted if you only object to specific vaccinations
You must demonstrate that you oppose vaccinations in all forms; you cannot “pick and choose” between the vaccinations. However, the fact that you have received certain vaccinations but not others is not automatic grounds for the denial of a waiver. Instead, the officer should consider the reasons provided for having received those vaccines. For example, your religious beliefs or moral convictions may have changed substantially since the date the particular vaccinations were administered, or the applicant is a child who may have already received certain vaccinations under the routine practices of an orphanage. These examples do not limit the officer’s authority to consider all credible circumstances and accompanying evidence.
Your objection must be based on religious beliefs or moral convictions;
Your religious beliefs must be balanced against the benefit to society as a whole. The officer should be mindful that vaccinations offend certain persons' religious beliefs.
The religious or moral beliefs must be sincere.
To protect only those beliefs that are held as a matter of conscience, you must demonstrate that you hold the belief sincerely, and in subjective good faith of an adherent. Even if these beliefs accurately reflect the applicant's ultimate conclusions about vaccinations, they must stem from religious or moral convictions, and must not have been framed in terms of a particular belief so as to gain the legal remedy desired, such as this waiver.
The focus of the waiver adjudication should be on whether that claimed belief or moral conviction is truly held, that is, whether it is applied consistently in the applicant’s life.
You do not need to be a member of a recognized religion or attend a specific house of worship.
The USCIS office will try to distinguish between strong religious beliefs or moral convictions and mere preference.
Religious beliefs or moral convictions are generally defined by their ability to cause an adherent to categorically disregard self-interest in favor of religious or moral tenets. The applicant has the burden of establishing a strong objection to vaccinations that is based on religious beliefs or moral convictions, as opposed to a mere preference against vaccinations.
What if I oppose vaccination for my child due to moral or religious reasons?
You may apply for a waiver on your child’s behalf.
I decide to get vaccinated, do I have to complete the entire dosage/ series of the vaccine for immigration purposes?
Vaccine series have minimum age requirements and typically require months to years to complete.
For immigration purposes, you only need to complete the first dosage.
What happens if I do not apply for a waiver or exemption and I do not have the required vaccinations?
Under the Immigration and Nationality Act (INA) section 212(a)(1)(A)(ii), a noncitizen who seeks admission as an immigrant or who seeks adjustment of status to that of a lawful permanent resident, who fails to show proof that they were vaccinated against vaccine-preventable diseases, is inadmissible and therefore ineligible for admission or adjustment of status.
In plain language, this means your application for permanent residency may be denied as you will be inadmissible without a vaccine waiver or exemptions
How can an immigration lawyer help?
We can help evaluate your options and advocate on your behalf. For example, if you have a medical contraindication and qualify for a blanket waiver, we can help prepare a package for you to take to your immigration medical examination. If you have moral or religious opposition to vaccination, we can assist with the waiver application.
To get started, please schedule a strategy session.